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Talapatra D, Snider L, Coleman J, Thompson T, Reinhardt JS, Hessl D, Riley K. Deviation scores: An innovative approach to interpreting cognitive test results for individuals with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1218-1228. [PMID: 37553958 PMCID: PMC10591767 DOI: 10.1111/jar.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/31/2023] [Accepted: 06/08/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Students with Intellectual Disability undergo frequent cognitive testing. Testing with this population is limited by insensitivity to relative strengths and weaknesses due to floor effects. AIM The study explored the utility of deviation scores via four case studies as a supplement to educational decision-making. METHODS Four students with Intellectual Disability completed cognitive testing. Deviation scores were calculated using age dependent raw z-score transformations to determine deviation from the standardization sample norms. RESULTS The application of deviation scores highlighted true relative strengths and weaknesses for students with Intellectual Disability rather than documenting previously known deficits. The four cases studies illustrated where deviation scores could, or could not, add value above and beyond traditional scoring. DISCUSSION Deviation scores can supplement placement and service decisions for students. Practical and psychometric considerations are reviewed. CONCLUSION The findings highlight the usefulness of deviation scores in providing meaningful information to school- and clinic-based practitioners.
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Affiliation(s)
- Devadrita Talapatra
- College of Education, Teaching and Learning Sciences Department, University of Denver, Denver, Colorado, USA
| | - Laurel Snider
- College of Education, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jeanine Coleman
- Office of the Provost, Regis University, Denver, Colorado, USA
| | - Talia Thompson
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jessica S. Reinhardt
- College of Education, Department of Psychological Studies in Education, Temple University, Philadelphia, Pennsylvania, USA
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Karen Riley
- Office of the President, Slippery Rock University, Slippery Rock, PA, USA
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Houck EJ, Dracobly JD. Trauma-Informed Care for Individuals with Intellectual and Developmental Disabilities: From Disparity to Policies for Effective Action. Perspect Behav Sci 2023; 46:67-87. [PMID: 37006597 PMCID: PMC10050265 DOI: 10.1007/s40614-022-00359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
People with intellectual disabilities (ID) are an often overlooked minority population. They experience significant health disparities and a high risk of exposure to traumatic events that can lead to stress-related disorders. Access to effective treatments for stress-related disorders is limited for people with ID due to a lack of appropriate assessments and common communication deficits. We discuss and analyze four factors that have led to these disparities: (1) historical segregation; (2) society's response to identification of trauma in vulnerable populations; (3) lack of accessible assessments and treatments for stress disorders in people with ID; and (4) communication deficits common in people with ID. Based on this analysis, we suggest behavior analysts advocate for policy development that would (1) increase acknowledgement of trauma in people with ID and mandate sharing of information about trauma across providers; (2) require observable and measurable goals be included in the assessment and treatment of trauma-related behavior change; and (3) increase funding for services and research in this area.
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Affiliation(s)
- Elizabeth J. Houck
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
| | - Joseph D. Dracobly
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
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Cook S, Hole R. Trauma, intellectual and/or developmental disability, and multiple, complex needs: A scoping review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 115:103939. [PMID: 33934926 DOI: 10.1016/j.ridd.2021.103939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Trauma is a significant underlying factor in the multimorbidity of people with Intellectual and/or Development Disabilities (IDD). This relationship is further complicated by a growing recognition of a subset of multiply stigmatized individuals with an IDD and complex, intersecting health and social needs. AIM The aim of this review was to examine what is known about trauma and people with an IDD and complex needs, as defined by Community Living British Columbia's (CLBC) Multiple, Complex Needs (MCN) framework, through a broad review of relevant literature. METHOD AND PROCEDURES We conducted a scoping review of the peer-reviewed (9 disability journals; 7 academic databases) and grey (2 grey literature databases) on IDD and trauma through an inclusive approach that used search criteria drawn from the defining features of CLBC's MCN Framework. OUTCOMES AND RESULTS Apart from there being a limited amount of research on trauma and IDD, two key findings emerged. Through differing approaches that get at issues of trauma in different ways (i.e., through adverse life events or experiences of abuse), the first finding is that the research related to trauma and IDD is not cleanly linked together. The second is the focus on treatment services or interventions and not on what's happening at the organizational or system level. CONCLUSION AND IMPLICATIONS There is limited research on trauma and IDD making it even more important to unify the evidence that exists. However, the literature is not integrated across different theoretical and disciplinary perspectives. In addition, the focus of trauma-related research that is occurring is interventions at the individual versus system level. Also needed are studies that explore trauma-informed practice from an organizational or top-down perspective.
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Affiliation(s)
- Shelley Cook
- UBC Canadian Institute for Inclusion and Citizenship ARTS/FHSD, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Rachelle Hole
- UBC Canadian Institute for Inclusion and Citizenship ARTS/FHSD, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
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McNally P, Taggart L, Shevlin M. Trauma experiences of people with an intellectual disability and their implications: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:927-949. [PMID: 33772975 DOI: 10.1111/jar.12872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with an intellectual disability are more vulnerable to psychological trauma compared with the general population. The aim of this scoping review was to identify the current status of the literature on trauma that is specific to the experiences of adults with an intellectual disability, living in community settings. METHODS A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) framework. Forty-one international papers were reviewed spanning 2000-2020, and their quality assessed using the MMAT. FINDINGS (1) Aggressive behaviours can be symptoms of trauma, (2) there are appropriate assessment tools for the impact of trauma, (3) evidence-based interventions for trauma may be effective, and (4) factors associated with disability can be experienced as traumatic. CONCLUSION There is a growing body of literature highlighting assessment needs and potential interventions for people with an intellectual disability who have experienced psychological trauma. Further research is needed to develop trauma-informed pathways.
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Affiliation(s)
- Paddy McNally
- Institute of Nursing and Health Science, Ulster University, Newtownabbey, UK
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Cowles M, Randle-Phillips C, Medley A. Compassion-focused therapy for trauma in people with intellectual disabilities: A conceptual review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:212-232. [PMID: 29759022 DOI: 10.1177/1744629518773843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.
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Affiliation(s)
- Megan Cowles
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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Siegel M, McGuire K, Veenstra-VanderWeele J, Stratigos K, King B, Bellonci C, Hayek M, Keable H, Rockhill C, Bukstein OG, Walter HJ. Practice Parameter for the Assessment and Treatment of Psychiatric Disorders in Children and Adolescents With Intellectual Disability (Intellectual Developmental Disorder). J Am Acad Child Adolesc Psychiatry 2020; 59:468-496. [PMID: 33928910 DOI: 10.1016/j.jaac.2019.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 12/22/2022]
Abstract
Intellectual disability (intellectual developmental disorder) (ID/IDD) is both a psychiatric disorder and a risk factor for co-occurring psychiatric disorders in children and adolescents. DSM-5 introduced important changes in the conceptualization and diagnosis of ID/IDD, and current research studies clarify assessment and treatment of co-occurring psychiatric disorders in this population. Optimal assessment and treatment of psychiatric illness in children and adolescents with ID/IDD includes modifications in diagnostic and treatment techniques, appreciation of variations in the clinical presentation of psychiatric disorders, an understanding of the spectrum of etiologies of behavioral disturbance, and knowledge of psychosocial and medical interventions.
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Bond L, Carroll R, Mulryan N, O'Dwyer M, O'Connell J, Monaghan R, Sheerin F, McCallion P, McCarron M. The association of life events and mental ill health in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:454-465. [PMID: 30697858 DOI: 10.1111/jir.12595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposures to life events are associated with emotional, psychological and behavioural problems in those with intellectual disability (ID). Older adults with ID may experience different life events given differences in living circumstances, cognitive decline, greater dependency on others and less autonomy. This study examines the relationship of life events and mental ill health in an older ID population in Ireland. METHODS The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. The frequency of life events was assessed using a 20-item checklist, and the level of stress experienced was assessed using a three-point Likert scale measuring the burden of the life event. The associations of life events with factors associated with mental ill health were measured using a variety of self-report and proxy completed questionnaires. RESULTS For the study population, 88.1% had been exposed to at least one life event in the preceding 12 months and 64.5% to two or more life events. Frequency and burden of life events were significantly higher in individuals living in institutional settings and in individuals with any current psychiatric condition, increased depressive and anxiety symptoms, challenging behaviour and reported poorer self-rated mental and physical health. More life events were significantly associated with new psychiatric diagnoses as well as initiation and increased dosage of mood stabilising, hypnotic and sedative medications. CONCLUSIONS Life events are significantly associated with mental ill health in the older ID population. Service providers must focus on limiting the exposure to these events and, in situations where they cannot be avoided, should support and manage individuals compassionately and effectively, prioritising their mental and physical well-being.
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Affiliation(s)
- L Bond
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - R Carroll
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - N Mulryan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Daughters of Charity Disability Support Services, Dublin, Ireland
| | - M O'Dwyer
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J O'Connell
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - R Monaghan
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - F Sheerin
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Temple School of Social Work, Temple University, Philadelphia, PA, USA
| | - M McCarron
- The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Vervoort-Schel J, Mercera G, Wissink I, Mink E, van der Helm P, Lindauer R, Moonen X. Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102136. [PMID: 30274163 PMCID: PMC6210466 DOI: 10.3390/ijerph15102136] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/11/2018] [Accepted: 09/26/2018] [Indexed: 01/11/2023]
Abstract
Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).
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Affiliation(s)
- Jessica Vervoort-Schel
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands.
- Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands.
| | - Gabriëlle Mercera
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands.
| | - Inge Wissink
- Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands.
| | - Emmelie Mink
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands.
- Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands.
| | - Peer van der Helm
- Expert Center Social Work and applied Psychology, Professional University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands.
- Fier, National Expertise and Treatment Center, Holstmeerweg 1, 8936 AS Leeuwarden, The Netherlands.
| | - Ramón Lindauer
- Amsterdam UMC, University of Amsterdam, Department Child and Adolescent Psychiatry Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- De Bascule, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
| | - Xavier Moonen
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands.
- Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands.
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Hove O, Assmus J, Braatveit K, Havik OE. Inter-rater reliability of professional-caregiver-reported life events in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:697-706. [PMID: 28612474 DOI: 10.1111/jir.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/17/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The inter-rater reliability (IRR) of the measure of life events in adults with intellectual disabilities was investigated. METHOD Two staff members for each of 79 adults with intellectual disabilities (ID) living in group homes used a checklist to report the adults' exposure to and intensity of life events over the previous 12 months. The IRR was estimated with intraclass correlation analysis (ICC). The factors of the level of ID, number of years the rater knew the rated person and quality of community care were investigated for possible associations with level of reliability. RESULTS The ICC values for the occurrence of life events were .44-.80 depending on the category of life events. In general, intensity measures showed lower ICC values. When the rater had known the person rated for 2 or more years or the quality of community care was high, the ICC values increased, whereas lower levels of ID were associated with lower ICC values. CONCLUSIONS Inter-rater reliability in general was found to be acceptable. Further development and research are needed to improve the reliability of life event measures for more severe ID.
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Affiliation(s)
- O Hove
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - J Assmus
- Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - K Braatveit
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - O E Havik
- Department of Clinical Psychology, Universitetet i Bergen, Bergen, Norway
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Hove O, Assmus J, Havik OE. Type and Intensity of Negative Life Events Are Associated With Depression in Adults With Intellectual Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:419-431. [PMID: 27611352 DOI: 10.1352/1944-7558-121.5.419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study investigated the associations between types and intensity of life events and symptoms of depression among adults with intellectual disabilities. A community sample (N = 593) was screened for current depression and exposure to life events (i.e., loss, illness, change, and bullying) during the previous 12 months. Symptoms of depression were measured using the Psychopathology Checklists for Adults With Intellectual Disabilities. Exposure to three of the four types of life events studied (loss, illness, and bullying) and the intensity of the events were associated with depression, particularly in the cases of loss of relatives and bullying. Quality of care moderated the association between bullying and depression and may buffer the adverse consequences of bullying.
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Affiliation(s)
- Oddbjørn Hove
- Oddbjørn Hove, Department of Research and Innovation, Helse Fonna HF, and Department of Clinical Psychology, University of Bergen, Norway; Jörg Assmus, Center for Clinical Research, Haukeland University Hospital, Norway; and Odd E. Havik, Department of Clinical Psychology, University of Bergen, Norway
| | - Jörg Assmus
- Oddbjørn Hove, Department of Research and Innovation, Helse Fonna HF, and Department of Clinical Psychology, University of Bergen, Norway; Jörg Assmus, Center for Clinical Research, Haukeland University Hospital, Norway; and Odd E. Havik, Department of Clinical Psychology, University of Bergen, Norway
| | - Odd E Havik
- Oddbjørn Hove, Department of Research and Innovation, Helse Fonna HF, and Department of Clinical Psychology, University of Bergen, Norway; Jörg Assmus, Center for Clinical Research, Haukeland University Hospital, Norway; and Odd E. Havik, Department of Clinical Psychology, University of Bergen, Norway
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Taylor JL, Gotham KO. Cumulative life events, traumatic experiences, and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. J Neurodev Disord 2016; 8:28. [PMID: 27468315 PMCID: PMC4962443 DOI: 10.1186/s11689-016-9160-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Co-occurring mood and anxiety symptomatology is commonly observed among youth with autism spectrum disorders (ASD) during adolescence and adulthood. Yet, little is known about the factors that might predispose youth with ASD to mood and anxiety problems. In this study, we focus on the role of cumulative stressful life events and trauma in co-occurring psychopathology among youth with ASD who are preparing to exit high school. Specifically, we examined the distribution of cumulative life events and traumatic experiences and their relations with mood and anxiety symptomatology. Methods Participants included 36 youth with ASD, all of whom were in their last year of high school. Cumulative life events and trauma were assessed by parent report. Mood and anxiety symptomatology was determined using a variety of methods (structured interview, questionnaire, self- and informant report). Frequencies were used to examine the distributions of cumulative life events (count of total events) and trauma (coded into any trauma vs. no trauma), as well as mood and anxiety symptomatology (categorized into clinical-level, sub-threshold, or none for each). Bivariate relations between life events/trauma and mood/anxiety symptomatology were assessed using analysis of variance and chi-square. Ordinal logistic regression models were used to test whether significant bivariate relations remained after controlling for the sex of the youth with ASD and his/her IQ. Results Over 50 % of youth had experienced at least one trauma. Nearly one half had clinical-level mood or anxiety symptomatology. There was a statistically significant relation between absence/presence of trauma and mood symptomatology; nearly 90 % of the youth with clinical-level mood symptoms had at least one trauma, compared to 40 % of those with no mood symptomatology. Conclusions Our findings suggest that contextual factors such as trauma might be important for the development of mood symptomatology in individuals with ASD. Although this idea is well-accepted in typically developing populations, contextual factors are rarely studied in investigations of psychopathology or transition outcomes in ASD. Given the high rates of psychiatric comorbidities in this population, future research should continue to identify the range of possible factors—both behavioral and contextual—that might influence the emergence of these disorders. Electronic supplementary material The online version of this article (doi:10.1186/s11689-016-9160-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Lounds Taylor
- Department of Pediatrics and Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, PMB 40 - 230 Appleton Pl., Nashville, TN 37203 USA
| | - Katherine O Gotham
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Vanderbilt Kennedy Center, 1200 21st Ave. S, suite 2272, Nashville, TN 37203 USA
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Bertelli MO, Munir K, Harris J, Salvador-Carulla L. "Intellectual developmental disorders": reflections on the international consensus document for redefining "mental retardation-intellectual disability" in ICD-11. Adv Ment Health Intellect Disabil 2016; 10:36-58. [PMID: 27066217 PMCID: PMC4822711 DOI: 10.1108/amhid-10-2015-0050] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization's (WHO's) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11. DESIGN/METHODOLOGY/APPROACH A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences. FINDINGS The WG recommended a synonym set ("synset") ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as "a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features. ORIGINALITY/VALUE Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.
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Affiliation(s)
- Marco O Bertelli
- Scientific Director at CREA, Research and Clinical Centre, San Sebastiano Foundation, Florence, Italy and President at EAMHID, European Association for Mental Health in Intellectual Disability, Florence, Italy
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James Harris
- School of Medicine, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland. USA
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia and Mental Health Policy Unit, Brain and Mind Institute, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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O'Shea LE, Picchioni MM, McCarthy J, Mason FL, Dickens GL. Predictive validity of the HCR-20 for inpatient aggression: the effect of intellectual disability on accuracy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1042-1054. [PMID: 25683589 DOI: 10.1111/jir.12184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/19/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND People with intellectual disability (ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 (HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID. METHOD A pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID (n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID (n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis. RESULTS The HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID. CONCLUSIONS This study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered individuals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID.
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Affiliation(s)
- L E O'Shea
- Academic Department, St. Andrew's, Northampton, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - M M Picchioni
- Academic Department, St. Andrew's, Northampton, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - J McCarthy
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - F L Mason
- Academic Department, St. Andrew's, Northampton, UK
| | - G L Dickens
- Academic Department, St. Andrew's, Northampton, UK
- School of Social and Health Sciences, Abertay University, Dundee, UK
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14
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Berg KL, Shiu CS, Msall ME, Acharya K. Victimization and depression among youth with disabilities in the US child welfare system. Child Care Health Dev 2015; 41:989-99. [PMID: 25761940 DOI: 10.1111/cch.12233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2015] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to examine the prevalence of victimization among a United States-wide cohort of youth with disabilities (YWD) investigated for maltreatment in the child welfare system (CWS) and their correlation with mental health. METHODS Data were drawn from baseline interviews in the second National Survey of Child and Adolescent Well-Being, a national representative survey of youth involved in the CWS. Interviews took place between 2008 and 2009 and included 675 youth, 11-17 years old and residing with biological families across 83 counties nationwide. The sample consisted of 405 females (60.1%) and 270 males (39.9%), mean age = 13.5 years. We identified YWD if they reported one or more physical or neurodevelopmental health condition (n = 247). Reported victimization experiences and Children's Depression Inventory (CDI) scores were analysed using weighted regression analyses. RESULTS One-quarter of YWD in the CWS reported three or more victimizations during the prior year compared with 19% of youth without disabilities. The odds of YWD reporting a one-unit increase in level of victimization was 75% higher (P < 0.05) than youth without disabilities. Prevalence of clinical depression was significantly higher among YWD (14 vs. 5.5%; P < 0.05). Unlike youth without disabilities, the odds of clinical depression were 92% higher for every one-unit increase in victimization among YWD, controlling for covariates (P < 0.05). Of CWS-involved youth who reported three or more victimizations, 24.4% of YWD and 2.2% of non-disabled youth had CDI scores in the clinical range. CONCLUSION YWDs in the US CWS are at high risk of experiencing victimization and clinical depression. Our findings suggest that health professionals need to screen CWS-involved YWD for multiple forms of victimization, and develop and implement trauma-informed services that target the mental health sequelae that may jeopardize their independence in adulthood.
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Affiliation(s)
- K L Berg
- The College of Public Health, Temple University, Philadelphia, PA, USA
| | - C-S Shiu
- Social Work, University of Washington, Seattle, WA, USA
| | - M E Msall
- Developmental & Behavioral Pediatrics at University of Chicago Medicine, University of Chicago Medicine, Chicago, IL, USA.,Kennedy Research Center on Intellectual and Developmental Disabilities, Comer Children's Hospital, Chicago, IL, USA
| | - K Acharya
- Department of Disability and Human Development and Pediatrics, University of Illinois-Chicago, Chicago, IL, USA.,Department of Health and Human Services, Leadership Education in Neurodevelopmental and Related Disorders Training Program (LEND), Chicago, IL, USA
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15
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Catani C, Sossalla IM. Child abuse predicts adult PTSD symptoms among individuals diagnosed with intellectual disabilities. Front Psychol 2015; 6:1600. [PMID: 26539143 PMCID: PMC4609831 DOI: 10.3389/fpsyg.2015.01600] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022] Open
Abstract
Prior research has shown that people with intellectual disabilities (ID) are more likely to experience child abuse as well as other forms of traumatic or negative events later in life compared to the general population. Little is known however, about the association of these experiences with adult mental health in intellectually disabled individuals. The present study aimed to assess whether child abuse in families and institutions as well as other types of adverse life events, were associated with current posttraumatic stress disorder (PTSD) and depression symptoms in individuals with ID. We conducted clinical interviews which included standardized self-report measures for childhood abuse, PTSD, and depression in an unselected sample of 56 persons with a medical diagnosis of ID who were attending a specialized welfare center. The frequency of traumatic experiences was very high, with physical and emotional child abuse being the most common trauma types. 87% of the persons reported at least one aversive experience on the family violence spectrum, and 50% of the sample reported a violent physical attack later in adulthood. 25% were diagnosed with PTSD and almost 27% had a critical score on the depression scale. Physical and emotional child abuse was positively correlated with the amount of institutional violence and the number of general traumatic events, whereas childhood sexual abuse was related to the experience of intimate partner violence in adult life. A linear regression model revealed child abuse in the family to be the only significant independent predictor of PTSD symptom severity. The current findings underscore the central role of child maltreatment in the increased risk of further victimization and in the development of mental health problems in adulthood in intellectually disabled individuals. Our data have important clinical implications and demonstrate the need for targeted prevention and intervention programs that are tailored to the specific needs of children and adults with intellectual disability.
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Affiliation(s)
- Claudia Catani
- Department of Psychology, Bielefeld University , Bielefeld, Germany
| | - Iris M Sossalla
- Department of Psychology, Bielefeld University , Bielefeld, Germany
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16
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Conder JA, Mirfin-Veitch BF, Gates S. Risk and Resilience Factors in the Mental Health and Well-Being of Women with Intellectual Disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:572-83. [DOI: 10.1111/jar.12153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Sue Gates
- Donald Beasley Institute; Dunedin New Zealand
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17
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Scott HM, Havercamp SM. Mental health for people with intellectual disability: the impact of stress and social support. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:552-64. [PMID: 25354124 DOI: 10.1352/1944-7558-119.6.552] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A large, nationally representative sample from a preexisting dataset, the National Core Indicators, was used to examine the impact of stress and social support on the mental health of adults with intellectual disability (ID). Stress was significantly correlated with both mental illness and severity of behavior problems, with each additional stressor increasing the odds of poor mental health by 20%. This relationship held, even after controlling for level of ID, gender, and place of residence. Lack of social support was associated with having a mental illness; individuals who lacked social support were twice as likely to have a mental illness. The importance of considering these factors in the prevention, diagnosis, and treatment of mental health in this population is discussed.
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18
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King BH, de Lacy N, Siegel M. Psychiatric assessment of severe presentations in autism spectrum disorders and intellectual disability. Child Adolesc Psychiatr Clin N Am 2014; 23:1-14. [PMID: 24231163 DOI: 10.1016/j.chc.2013.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Children with autism spectrum and related disorders and intellectual disability are not protected from the experience of psychiatric illnesses. Many factors can contribute to exacerbation of existing behavioral symptoms or to the emergence of new psychiatric problems. The psychiatric assessment must thus take into account a range of possible etiologic or contributory factors. The approach outlined in this article highlights the value of assessing 4 broad domains, including diagnostic (genetic) factors, medical considerations, developmental influences, and environmental factors. Examples of how the consideration of each of these domains may inform the diagnostic formulation are highlighted.
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Affiliation(s)
- Bryan H King
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Autism Center, Seattle Children's Hospital, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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19
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20
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Hulbert-Williams L, Hastings R, Owen DM, Burns L, Day J, Mulligan J, Noone SJ. Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:48-60. [PMID: 23627774 DOI: 10.1111/jir.12050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. METHODS Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over time was explored. RESULTS Hierarchical linear regression analyses demonstrated a contribution of life events to the prediction of later psychological problems after controlling for earlier psychological problems. Exploratory analyses showed that the relationship between life events and psychological problems might be unidirectional, and non-spurious; remaining present once the impact of other correlates of psychological problems was controlled. CONCLUSIONS These data offer support for the status of life events (with a negative valence) as a risk factor for psychological problems in adults with ID. To establish life events as a causal risk factor, research is needed to examine the mechanisms via which life events have their impact on psychological well-being.
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Affiliation(s)
- L Hulbert-Williams
- School of Applied Sciences, University of Wolverhampton, Wolverhampton, UK
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21
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Abstract
Children and adolescents with intellectual disabilities (IDs), often diagnosed with comorbid psychiatric disorders, are a vulnerable population who may be at risk for developing suicidal thoughts and behaviors. Previous research has demonstrated that direct suicide screening can rapidly and effectively detect suicide risk and facilitate further clinical evaluation and management. Currently, there are no measures that screen for suicide risk designed specifically for individuals with ID. A review of the literature was conducted to (1) estimate the prevalence of suicidal thoughts, behaviors, and deaths by suicide in children and adolescents with ID; (2) describe associations between youth with ID and suicide risk; and (3) identify the limitations of commonly used suicide screening measures developed for non-ID youth. The literature review confirms that suicide risk exists in this population; youth with ID think about, attempt, and die by suicide. Standardized suicide risk screening is challenged by the lack of measures developed for this population. A summary of the findings is followed by a discussion of the practical clinical considerations surrounding the assessment of suicide risk in youth with ID.
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22
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Hermans H, Evenhuis HM. Life events and their associations with depression and anxiety in older people with intellectual disabilities: results of the HA-ID study. J Affect Disord 2012; 138:79-85. [PMID: 22305429 DOI: 10.1016/j.jad.2011.12.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/08/2011] [Accepted: 12/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities (ID) may be exposed to more life events due to different living circumstances and limited coping abilities. The frequency of life events may increase with age due to age-related decline, loss of significant others and forced relocations. We studied the occurrence of life events in adults with mild to profound ID aged ≥ 50 years and their association with depression and anxiety. METHODS Occurrence and burden of life events were assessed with a checklist of 28 items, completed by professional caregivers. Depression and anxiety were assessed with self-report and informant-report screening instruments (n=988) and with a psychiatric interview (n=286). Associations with depression and anxiety were studied for life events in general and for specific life events. RESULTS 97% of the participants had been exposed to multiple life events during the preceding year and 72% had been exposed to one or more negative life events. The frequency was significantly higher in participants aged 65 years or over, in participants with mild or moderate ID and in participants with depression or anxiety. Minor physical illness and problems with a fellow resident were significantly associated with depression and anxiety, decline or loss of mobility and loss of leisure-time activities with depression and change at work or from work with anxiety. LIMITATIONS This study was cross-sectional and therefore lacks reliable information about causality. CONCLUSIONS Given the high prevalence of life events and their association with depression and anxiety, life events should be better monitored and, if possible, prevented.
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Affiliation(s)
- Heidi Hermans
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center Rotterdam, The Netherlands.
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Intelligenzminderung. PSYCHIATRIE UND PSYCHOTHERAPIE DES KINDES- UND JUGENDALTERS 2012. [PMCID: PMC7123948 DOI: 10.1007/978-3-642-19846-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schwachsinn Der Gebrauch des Terminus »Schwachsinn« ist wegen seines globalen und wenig präzisen Charakters und durch seine historisch und umgangssprachlich bedingte sozial diskriminierende Tönung inzwischen in der wissenschaftlichen Literatur zu Recht weitgehend aufgegeben worden. In der Rechtsprechung speziell in der Forensik ist Schwachsinn als eine schuldausschließende bzw. schuldminderende juristische Kategorie ein nach wie vor gebräuchlicher Begriff.
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[Psychotherapy in intellectual disability. Theoretical background and implementation]. DER NERVENARZT 2010; 81:827-36. [PMID: 20119654 DOI: 10.1007/s00115-009-2917-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Every third person with intellectual disability suffers from additional mental health problems, among others phobic disorders. Yet we do not know whether psychotherapeutic methods that are effective in the normal population are applicable to people with intellectual disabilities. PATIENTS AND METHODS We give a survey of the development and the present state of the art of psychotherapy, particularly with regard to phobic disorders in intellectual disability. Therapeutic recommendations described in the literature will be evaluated in a case study of one patient. RESULTS The confrontation with the phobic stimulus is the basis of behavior therapy for people with intellectual disability as well. However, with respect to the special needs of these people, some modifications need to be considered in the treatment strategy. In addition to some general rules like simple language or the use of visual materials, some techniques of intervention turned out to be particularly effective, e.g., graduated in vivo exposure, involving significant others, contingency management, and coping strategies. CONCLUSION Specific phobias in intellectual disability can be treated with behavior therapy as well. However, the special needs of these people need to be considered.
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Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought. Clin Child Fam Psychol Rev 2009; 13:46-76. [DOI: 10.1007/s10567-009-0061-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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